Have you had a fever, cough, shortness of breath, sore throat, any new loss of smell or taste, muscle pain, or flu-like symptoms in the past 14 days?

Have you been near or had physical contact with anyone who has had these symptoms or has been diagnosed with COVID-19 in the past 14 days?

Have you traveled out of San Francisco or Northern California in the last 14 days?

Have you been in contact with anyone who has traveled to San Francisco or Northern California from somewhere else?